Infecção ativa ou latente que requer resolução / profilaxia antes de iniciar ICI (pemb...

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ID	`RF-UROTHELIAL-INFECTION-SCREENING`
Tipo	Sinal de alerta
Estado	reviewed 2026-04-27 \| pending_clinical_signoff
Doenças	`DIS-UROTHELIAL`
Fontes	`SRC-EAU-BLADDER-2024` `SRC-NCCN-BLADDER-2025`

Origem da bandeira vermelha

Definição	Active or latent infection requiring resolution / prophylaxis before initiating ICI (pembro / avelumab) or ICI+ADC (enfortumab-vedotin + pembrolizumab) or platinum-based chemo in advanced urothelial cancer: HBsAg+ or anti-HBc+ (HBV reactivation on cytotoxic chemo and on ICI), HCV-RNA+, HIV+, active TB, or active uncontrolled urinary tract / pyelonephritis infection (especially relevant in UC with ureteral obstruction / hydronephrosis).
Direcção clínica	aguentar
Categoria	rastreamento de infecções

Lógica de Desencadeamento

{
  "any_of": [
    {
      "finding": "hbsag",
      "value": "positive"
    },
    {
      "finding": "anti_hbc_total",
      "value": "positive"
    },
    {
      "finding": "hcv_rna",
      "value": "positive"
    },
    {
      "finding": "hiv_status",
      "value": "positive"
    },
    {
      "finding": "active_tb",
      "value": true
    },
    {
      "finding": "active_uncontrolled_infection",
      "value": true
    },
    {
      "finding": "active_pyelonephritis",
      "value": true
    }
  ],
  "type": "composite"
}

Notas

HBsAg+ → entecavir or tenofovir from before first cycle through ≥6 months post-last-systemic-therapy. UC-specific: ureteral obstruction + hydronephrosis is common at presentation and predisposes to pyelonephritis — drain (percutaneous nephrostomy or ureteral stent) + treat infection before initiating cytotoxic chemo or ICI; uncontrolled urosepsis is contraindication to systemic therapy initiation. HIV+ with stable ART can receive ICI safely. ICI-related immune events (colitis, pneumonitis) can be confused with active infection — TB screening before ICI to avoid IRIS / TB worsening on immune reconstitution. Direction "hold" surfaces a workup-prerequisite annotation rather than switching indication.

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